Provider Demographics
NPI:1891936779
Name:AKSELROD, OLGA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:AKSELROD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1523
Mailing Address - Country:US
Mailing Address - Phone:201-775-7512
Mailing Address - Fax:212-452-3323
Practice Address - Street 1:225 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645
Practice Address - Country:US
Practice Address - Phone:201-775-7512
Practice Address - Fax:212-452-3323
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP 00215100363AS0400X
NY013140-1363AS0400X
NJ25MP00215100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical